In the past many methods have been developed to bring into apposition the edges of a wound or surgical incision so that the natural process of wound healing can occur. Among the products developed in the past that approximate wound edges include sutures made from various materials both naturally occurring and synthetic, many variations of tapes and metallic staples. All of these items involve methods that have advantages and disadvantages.
Sutures (or stitches) have the advantage of strength in holding the wound edges in close approximation but are somewhat complicated and time-consuming to place. Sutures also require a relatively high level of expertise and experience to use. Placement and removal of sutures may involve some pain and may require the use of local anesthetics. There is the inconvenience of a second visit to a healthcare professional which is usually required to remove the sutures.
Tape is simple and fast to use to approximate wound edges and requires little expertise and only minimal experience. However because the strength is dependent on adhesives that are pre-placed on the surface of the tape and are subject to losing their adhesive ability over time or with exposure to moisture, tape may not hold the wound edges close together for a long enough period of time to allow the natural wound healing process to occur.
Metallic staples have the advantage of strength in holding the wound edges close together but require expertise and experience to use them effectively. Like sutures, placement of staples may be painful and require the use of local anesthetics. Staples also involve the inconvenience of a second trip to have them removed by a healthcare professional. In addition, both sutures and staples may leave a scar pattern that is cosmetically unattractive.
Recently, adhesives have been developed to provide a way to bond wound edges in close approximation while the natural process of wound healing occurs. Products related to “super glue” or cyanoacrylates have been used to bond the wound edges together. The bond is formed when liquid cyanoacrylate is spread tangentially along the surfaces at the wound's edges spanning the edges. The liquid cyanoacrylate reacts with moisture on the surfaces and then hardens to form a solid mass that holds the wound edges together by bridging the edges together at their surfaces. It is important that the liquid cyanoacrylate not pass into the wound itself.
Techniques for the use of cyanoacrylates often involve having a healthcare professional apply the cyanoacrylate while holding the wound edges together with his gloved fingers or forceps. A total of 3–4 applications should be spread in layers directly over the junction of the tightly approximated wound edges allowing 10–15 seconds between applications for the liquid cyanoacrylate to set or harden. One recent article recommended that the total time that the wound edges should be held closely together is 2½ minutes. Also, it is critical that the wound edges be held in close approximation to ensure that none or a minimal amount of the adhesive enters the wound itself and is allowed to contact the structures under the skin. Further, holding the wound in close approximation also creates a better cosmetic result after healing has occurred (i.e., no scar or a less noticeable scar).
A device that will simplify the process and help healthcare professionals follow the proper procedure will ensure that these adhesives are used effectively. One patent describes a bandage having a porous bonding member or bonding pad that can be used in conjunction with a carrier member for wound apposition. However, the bonding pad is thick and therefore, has the disadvantage of not allowing direct visualization of the wound and the adjacent areas before, during and after its application.